66984

Removal of cataract with insertion of prosthetic lens

Code 66984. Medicare covered 8,319,156 of these. Here is what providers billed and what Medicare allowed, state by state.

$1,027.76Billed, national avg
$245.77Medicare allowed
4.2xBilled vs allowed
481.7xHighest vs lowest state

Providers in Virgin Islands billed the most for this, at $9,097.61. In Armed Forces Europe the average was $18.89. Same procedure code, same programme.

Whose price this is

These are Medicare figures. The billed column is what providers asked for. The allowed column is what Medicare agreed to pay. Neither is what an uninsured patient gets charged, and neither is what a private insurer negotiates.

The gap between the two columns is the point. A hospital billing three times what Medicare allows tells you the billed number was never a price. It was an opening position.

By state

StateBilledMedicare allowedGapServices
Virgin Islands$9,097.61$731.9812.4x597
Guam$5,498.28$852.596.4x954
New Jersey$5,102.88$874.445.8x78,388
Alaska$4,823.90$845.055.7x7,530
Northern Mariana Islands$4,646.76$543.818.5x57
California$4,163.66$893.654.7x233,162
Texas$4,087.54$712.725.7x205,967
Hawaii$3,061.33$813.973.8x9,852
Delaware$3,022.12$778.073.9x15,641
Nevada$2,776.43$751.233.7x25,856
Florida$2,720.54$720.353.8x209,108
Utah$2,649.38$636.624.2x23,852
Louisiana$2,550.44$617.564.1x37,469
Colorado$2,538.82$714.613.6x49,951
Pennsylvania$2,459.88$655.923.8x122,686
Indiana$2,364.03$583.294.1x90,012
Arizona$2,268.97$774.272.9x75,883
Oregon$2,254.07$750.003.0x37,529
Mississippi$2,251.79$613.793.7x41,864
Nebraska$2,247.67$575.293.9x33,708
Michigan$2,223.30$609.593.6x68,790
Washington$2,161.33$735.412.9x76,127
Oklahoma$2,126.03$567.053.7x57,577
Wyoming$2,122.08$521.254.1x7,265
Maryland$2,114.85$801.922.6x71,942
Kansas$2,113.40$557.433.8x47,469
District of Columbia$2,054.21$561.613.7x2,824
Montana$2,026.32$644.473.1x19,940
New Mexico$1,984.38$695.912.9x18,570
Missouri$1,861.52$459.324.1x85,726
South Dakota$1,830.42$511.753.6x22,838
Arkansas$1,813.74$602.173.0x39,406
Iowa$1,741.02$401.744.3x55,125
New York$1,648.99$383.864.3x237,522
Idaho$1,618.08$642.012.5x22,947
New Hampshire$1,604.00$344.514.7x36,690
North Dakota$1,519.26$405.703.7x19,489
Connecticut$1,141.51$229.125.0x71,559
South Carolina$1,049.67$232.014.5x209,722
Vermont$954.96$284.543.4x12,155
Georgia$886.26$182.264.9x301,209
Puerto Rico$794.67$612.811.3x2,610
Massachusetts$740.09$228.903.2x265,413
Tennessee$585.66$133.404.4x406,311
Virginia$542.22$154.243.5x440,847
Illinois$426.84$84.405.1x833,866
Ohio$414.27$109.813.8x570,297
North Carolina$365.60$79.684.6x711,789
Wisconsin$358.21$45.587.9x586,471
Alabama$278.71$72.563.8x317,168
West Virginia$258.57$83.593.1x77,849
Armed Forces Pacific$225.00$99.412.3x41
Kentucky$194.04$46.104.2x596,554
Minnesota$192.47$48.254.0x466,340
Rhode Island$171.94$47.623.6x81,120
Maine$122.70$39.403.1x177,253
Armed Forces Europe$18.89$8.942.1x249

Source: CMS Medicare Physician & Other Practitioners, by Geography and Service. Weighted by service volume across places of service.

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